Onsite Position*POSITION SUMMARYThe Corporate Manager of Managed Care Contracting is responsible for supervising and overseeing the gathering and preparation of monthly, quarterly and annual status of Managed Care reports on an individual and consolidated basis.
This position manages the implementation and renewal of new and / or existing contracts in a timely manner and is responsible for the contract terms and negotiations for all AHMC contracts.
This position is responsible to properly notify Ethos and MSO of any changes including rates and ensures that IMaCS and Rapid Reserves are updated upon implementation of the contract.
This position supervises all the Managed Care Contracting functions at the corporate level and directly supervises two full-time employees.
AHMC provides consulting services to six acute care hospitals, AHMC Anaheim Regional Medical Center with 223 beds, Garfield Medical Center with 21 1 beds, Greater El Monte Community Hospital with 115 beds, Doctors Hospital of Riverside 192, Seton Medical Center 350 beds, Monterey Park Hospital with 102 beds, San Gabriel Valley Medical Center with 273 beds, and Whittier Hospital Medical Center with 172 beds.
The facilities are Medicare and Medi-Cal certified and accredited by the Joint Commission on Accreditation of Healthcare Organizations.
The hospitals provide healthcare services reimbursed by Medicare, Medi-Cal, traditional insurance plans, PPO, HMO and under capitated arrangements.
ESSENTIAL JOB FUNCTIONSManages and maintains AHMC's financial reporting database and acts as the Avega super database administrator (SDBA).
Coordinates all managed care activities including planning, direction and negotiation, renegotiation, analysis, maintenance and implementation of all managed care agreements with current and prospective purchasers and providers of healthcare services.
Coordinates with Ethos management, hospital administration and staff regarding the implementation, evaluation and compliance with managed care contracts.
Ensures that current rates are input into IMaCS and Rapid Reserves and updates T&C with the revised Terms and Conditions.
Acts as the primary resource to address any issues as identified by Ethos.Manages operational issues including; performance improvement, contract negotiations and provides ongoing updates regarding negotiations with HMOs.
Assists hospital management regarding managed care, employee health plans and patient care service line issues.Maintains effective working and business relationships with the key physician organizations that direct the majority of the medical care in the market.
Evaluates the strategic value of physician organizations and makes recommendations based on financial implications.Partners with the hospital Business Development in relation to managed care activities.
Develops short / long term objectives for Managed Care that support strategic objectives.Develops and presents briefings and reports Managed Care strategies during the monthly operations review (MOR) meetings.
Develops quality indicators to monitor Managed Care activities and conducts a detailed analysis to determine profit / loss on all Managed Care contracts.
Maintains professional growth by keeping abreast of current industry standards, professional symposiums, networking and participation in community outreach events.
Conducts educational meetings and / or in-service as requested.Attends department specific education and / or training, in-service and staff meetings as requested.
Responsible for the proper recruitment of qualified personnel in order to meet the needs of the department.Counsels employees concerning personnel and / or employee relations issues.
Participates in employee recognition programs.Handles all aspects of compliance as well as the financial / operational reporting of capitation agreements via participation in Joint Operation Committee (JOC) meetings.
Abides by AHMC Code of Conduct, Policy and Procedures, and HIPPA compliance.Performs additional duties as assigned QualificationsMaster's Degree and / or equivalent experience in Managed Care modeling and / or financial analyses preferred.
5 years of progressive responsibilities in managed care contracting.Prior experience with financial planning and reporting systems (Avega, EZ Cap and SSRS reports) preferred.
Proficient in Microsoft Excel.Thorough understanding of the healthcare market and managed care operations. Strong personal communication and critical thinking skills.
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